New York State Medical Treatment Guidelines for Hip Osteoarthrosis in workers compensation patients

The guidelines set forth by the New York State Workers Compensation Board are designed to assist healthcare professionals in evaluating Hip Osteoarthrosis. These directives aim to support physicians and healthcare practitioners in determining the appropriate treatment for this condition.

Healthcare professionals specializing in Hip Osteoarthrosis can utilize the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable level of care for their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding care should involve collaboration between the patient and their healthcare provider.

Related Terms

• Arthritis
• Arthrosis
• Degenerative Arthritis
• Degenerative Arthrosis
• Degenerative Joint Disease
• Non-inflammatory Arthritis
• Osteoarthritis
• Osteoarthrosis

 

The primary cause of degenerative joint disease (DJD) in the hip is most commonly osteoarthritis (OA).

While osteoarthritis is the more commonly used term for this condition, osteoarthrosis is considered to be more technically precise as it signifies the absence of classic inflammation.

Osteoarthritis (OA) may arise in a single joint following a substantial traumatic injury, such as a fracture, and in such cases, its onset is frequently delayed by many years.

The typical pathway for hip osteoarthritis (OA) entails substantial joint destruction caused by various factors, which may be challenging to distinguish on a radiograph.

Hence, the accurate interpretation of findings that align with possible osteoarthritis on a radiograph is typically degenerative joint disease, rather than osteoarthrosis.

 

Diagnostic Studies

 

Antibodies to Assist in Diagnosing Hip Pain, Including Differentiating Inflammatory Rheumatic Disorders From Hip Osteoarthrosis

Using antibodies to help diagnose hip pain, including distinguishing between inflammatory rheumatic disorders and hip osteoarthrosis, is recommended for certain patients experiencing acute, subacute, chronic, or postoperative hip pain. This is particularly applicable for individuals with undiagnosed systemic arthropathies or peripheral neuropathies, or those with incomplete evaluations. When conducting diagnostic tests, it’s generally advisable to include the sedimentation rate. Additional tests, such as rheumatoid factor, antinuclear antibody level, and others, may also be considered.

The rationale behind utilizing antibodies lies in their effectiveness in confirming inflammatory arthritides in specific situations. Therefore, they are recommended for individuals exhibiting symptoms suggestive of potential rheumatoid disorders. The supporting evidence for employing antibodies in diagnosing hip pain is substantial.

 

C-Reactive Protein to Assist in Diagnosing Hip Pain, Including Differentiating Inflammatory Rheumatic Disorders From Hip Osteoarthrosis

Similarly, C-Reactive Protein (CRP) is recommended for diagnosing hip pain, aiding in distinguishing between inflammatory rheumatic disorders and hip osteoarthrosis, especially in select patients with acute, subacute, chronic, or postoperative hip pain. It serves as a non-specific inflammatory indicator and is particularly useful for undiagnosed patients with systemic arthropathies or peripheral neuropathies, or those with incomplete evaluations. In diagnostic testing, including the sedimentation rate, which is also non-specific, is generally advisable. Additional tests like rheumatoid factor and antinuclear antibody level may also be considered.

The rationale for using CRP aligns with its role as a helpful non-specific indicator, especially in confirming inflammatory arthritides in select circumstances. As a result, it is recommended for individuals displaying symptoms suggestive of potential rheumatoid disorders. The evidence supporting the use of C-Reactive Protein in diagnosing hip pain is well-established.

 

Erythrocyte Sedimentation Rate to Assist in Diagnosing Hip Pain, Including Differentiating Inflammatory Rheumatic Disorders From Hip Osteoarthrosis

Utilizing the Erythrocyte Sedimentation Rate (ESR) to aid in diagnosing hip pain, distinguishing between inflammatory rheumatic disorders and hip osteoarthrosis, is recommended for specific patients dealing with acute, subacute, chronic, or postoperative hip pain. It serves as a nonspecific indicator of inflammation, particularly beneficial for undiagnosed individuals with systemic arthropathies or peripheral neuropathies, or those undergoing incomplete evaluations. When conducting diagnostic tests, including the sedimentation rate is generally advised, along with potential additional tests such as rheumatoid factor, antinuclear antibody level, and others. The rationale behind this recommendation lies in the effectiveness of rheumatoid panels in confirming inflammatory arthritides in specific situations, making it a valuable tool for those exhibiting symptoms suggestive of potential rheumatoid disorders.

 

Other Non-Specific Inflammatory Markers to Assist in Diagnosing Hip Pain, Including Differentiating Inflammatory Rheumatic Disorders from Hip Osteoarthrosis

Similarly, other non-specific inflammatory markers are recommended to assist in diagnosing various forms of hip pain, including acute, subacute, chronic, and postoperative cases. This is particularly relevant for undiagnosed patients with systemic arthropathies or peripheral neuropathies, or those with incomplete evaluations. Diagnostic testing, including the sedimentation rate and potentially other tests like rheumatoid factor, antinuclear antibody level, and others, is generally advisable. The rationale mirrors that of ESR, with rheumatoid panels being useful in confirming inflammatory arthritides in specific circumstances. The evidence supporting the use of these non-specific inflammatory markers in diagnosing hip pain is well-established.

Evidence supporting the use of antibodies, C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), and other non-specific inflammatory markers in diagnosing hip pain is robust and reinforces their effectiveness in various scenarios.

 

Arthroscopic Examinations for Hip Disorders:

Arthroscopic examinations have primarily been utilized for treatable hip disorders and to diagnose hip osteoarthritis. However, it is not recommended as the sole method for diagnosing hip osteoarthritis. The rationale behind this recommendation is that the diagnosis of hip osteoarthritis is generally straightforward and does not require or benefit from arthroscopy. Therefore, arthroscopy is not suggested as a routine diagnostic procedure. The evidence supporting the use of arthroscopic examination for diagnosing hip osteoarthritis is discussed further.

 

Bone Scanning for Hip Pain Diagnosis

Bone scanning is recommended for select patients experiencing acute, subacute, or chronic hip pain to aid in diagnosing conditions such as osteonecrosis, neoplasms, or other situations with increased polyosthotic bone metabolism. This is particularly relevant for patients with suspicion of metastases, primary bone tumors, infected bone (osteomyelitis), inflammatory arthropathies, or trauma (e.g., occult fractures). The indications for bone scanning include patients with hip pain and suspicion of osteonecrosis, metastases, primary bone tumors, infected bone (osteomyelitis), inflammatory arthropathies, or trauma (e.g., occult fractures). The frequency, dose, and duration generally involve a single evaluation, with a second one indicated only if there is a significant change in symptoms after more than three months.

The rationale for recommending bone scanning lies in its potential as a helpful diagnostic test for evaluating suspected metastases, primary bone tumors, infected bone (osteomyelitis), inflammatory arthropathies, or trauma (e.g., occult fractures). It is not generally indicated for evaluating hip osteoarthritis but may be beneficial in cases of suspected early avascular necrosis (AVN) without X-ray changes. However, in cases where the diagnosis is secure, bone scanning is not indicated as it does not alter treatment or management.

 

Computerized Tomography Scans for Hip OA Diagnosis

Computerized tomography scans are not recommended for the routine diagnosis of hip osteoarthritis (OA).

 

Computerized Tomography for Post-Arthroplasty Dislocations

Computerized tomography is recommended for evaluating recurrent or chronic post-arthroplasty dislocations. Indications for its use include cases of recurrent dislocations post-arthroplasty or when there are contraindications for MRI. The benefits of this evaluation lie in providing imaging to explain dislocations and plan treatment.

Typically, one evaluation suffices, and a second one is rarely needed. The rationale behind recommending computerized tomography is its superiority over MRI in imaging most hip abnormalities, especially those involving calcified structures. A contrast CT is specifically recommended for select cases of recurrent dislocations after arthroplasty, with evidence supporting its use discussed further.

 

Helical Computerized Tomography for Bony Structure Imaging:

Helical computerized tomography (CT scan) is recommended for select patients experiencing acute, subacute, or chronic hip pain when advanced imaging of bony structures is deemed potentially helpful. It is also recommended for patients who require advanced imaging but have contraindications for MRI. The indications include individuals with hip pain needing advanced bony structure imaging and those with contraindications for MRI (e.g., implanted ferrous metal hardware). Similar to the previous scenario, one evaluation is generally sufficient, and a second one is rarely needed.

The rationale for recommending helical CT scanning is grounded in its historical consideration as superior to MRI for evaluating subchondral fractures, although definitive studies are lacking. Moreover, for patients with contraindications for MRI, such as those with implanted ferrous metal hardware but requiring evaluation of avascular necrosis (AVN), helical CT is recommended.

 

Local Anesthetic Injections for Hip Pain Diagnosis:

Local anesthetic injections are recommended to aid in diagnosing the cause of hip pain, particularly in cases of moderate to severe hip pain with uncertain origins. The frequency, dose, and duration typically involve a single injection, with a second evaluation rarely needed. Intraarticular hip injections with anesthetic agents are generally considered more effective when performed with a glucocorticosteroid, as this achieves both diagnostic and therapeutic purposes simultaneously. While a simple anesthetic injection may occasionally be helpful in select cases, the overall rationale emphasizes the diagnostic value of local anesthetic injections, supported by the absence of quality studies specifically evaluating them for assessing hip pain.

 

Electromyography for Peripheral Nerve Entrapments:

Electromyography, including nerve conduction studies, is recommended for select patients to assist in diagnosing subacute or chronic peripheral nerve entrapments, including the lateral cutaneous nerve to the thigh (meralgia paresthetica). Indications for this testing include patients with subacute or chronic paresthesias, with or without pain, especially when the diagnosis is unclear. It is generally not recommended for symptoms lasting under three weeks. The frequency, dose, and duration typically involve obtaining the studies at presentation, with reassessment indicated if the diagnosis remains unclear, symptoms progress, or months have passed. The rationale for using electromyography is its capability to confirm peripheral nerve entrapments, such as the lateral cutaneous nerve to the thigh.

 

Magnetic Resonance Imaging for Hip Joint Problems:

Magnetic Resonance Imaging (MRI) is considered the imaging test of choice for soft tissues and is the gold standard for evaluating osteonecrosis after X-rays. However, it is not recommended for the routine evaluation of acute, subacute, or chronic hip joint pathology, including degenerative joint disease. Instead, it is recommended for select hip joint pathology, especially when concerns involve soft tissue or when symptoms persist for more than three months. The rationale highlights that MRI findings consistent with osteoarthritis (OA) are particularly helpful for soft tissue abnormalities. While MRI without arthrography is suggested for joint evaluation (excluding the labrum), it is not recommended for routine hip imaging. The recommendation for MRI is focused on select hip joint pathology, particularly when concerns revolve around soft tissue pathology.

 

Radiographs (X-Rays) for Hip Osteoarthritis Diagnosis:

Radiographs, commonly known as X-rays, are recommended to assist in diagnosing hip osteoarthritis (OA). These are generally indicated for nearly all patients experiencing hip pain thought to potentially have hip OA. The frequency, dose, and duration typically involve obtaining X-rays once at the initial presentation. The rationale behind this recommendation lies in the effectiveness of X-rays for evaluating and diagnosing hip OA. The evidence supporting the use of radiographs for hip osteoarthritis diagnosis is discussed further.

 

Ultrasound for Hip OA Diagnosis:

Ultrasound is not recommended for diagnosing hip osteoarthritis (OA). The rationale for this recommendation is based on the lack of a clear indication for the use of ultrasound in evaluating osteoarthrosis. The evidence supporting the use of ultrasound for diagnosing hip OA is not substantial.

 

Medications

First-Line Medications for Hip OA:

For the majority of patients, ibuprofen, naproxen, or other older generation Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are recommended as the initial choice for medication. Acetaminophen (or the analog paracetamol) may serve as a reasonable alternative for those not suitable candidates for NSAIDs, although the prevailing evidence suggests that acetaminophen is moderately less effective. There is noteworthy evidence indicating that NSAIDs are as effective as opioids (including tramadol) for pain relief and are generally less impairing.

 

NSAIDs for Treatment of Hip OA:

NSAIDs are recommended for the treatment of acute, subacute, or chronic hip osteoarthritis (OA). Specifically, for acute, subacute, or chronic hip OA, NSAIDs are the preferred treatment, and over-the-counter (OTC) options should be tried initially. The frequency and duration of use can be tailored to individual needs, with discontinuation recommended upon the resolution of hip OA pain, lack of efficacy, or the development of adverse effects necessitating discontinuation.

 

NSAIDs for Patients at High Risk of Gastrointestinal Bleeding:

For patients at high risk of gastrointestinal bleeding, the concomitant use of cytoprotective classes of drugs, such as misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors, is recommended when using NSAIDs. Indications for this recommendation include patients with a high-risk factor profile who also require NSAIDs, especially for longer-term treatment. At-risk patients encompass those with a history of prior gastrointestinal bleeding, the elderly, diabetics, and cigarette smokers. Proton pump inhibitors, misoprostol, sucralfate, and H2 blockers are recommended, with doses and frequency adhering to manufacturer guidelines. There is generally no substantial belief in differences in efficacy between these agents for preventing gastrointestinal bleeding.

 

Acetaminophen for Hip OA Pain Treatment:

Acetaminophen is recommended for the treatment of hip osteoarthritis (OA) pain, especially in patients with contraindications for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Indications encompass all patients experiencing hip OA pain, regardless of whether it is acute, subacute, or chronic. The dose and frequency should align with the manufacturer’s recommendations, and it may be utilized on an as-needed basis. Caution is advised to avoid exceeding four grams per day due to evidence of hepatic toxicity. Discontinuation is warranted upon the resolution of pain, adverse effects, or intolerance.

 

Topical NSAIDs for Hip OA Treatment:

Topical NSAIDs are recommended for the treatment of acute, subacute, or chronic hip osteoarthritis (OA). While oral medications are generally recommended for most patients, topical NSAIDs serve as a reasonable alternative for those with contraindications for oral NSAIDs or intolerance. The frequency, dose, and duration should adhere to the manufacturer’s recommendations. Discontinuation is advised in cases of pain resolution, lack of efficacy, or the development of adverse effects necessitating discontinuation.

 

Norepinephrine Inhibiting Anti-depressants:

Norepinephrine inhibiting anti-depressants are not recommended for treating pain associated with hip osteoarthrosis.

 

Selective Serotonin Reuptake Inhibitors (SSRIs):

Selective Serotonin Reuptake Inhibitors (SSRIs) are not recommended for the treatment of pain associated with hip osteoarthrosis.

 

Anti-Convulsant Agents for Hip OA:

Anti-convulsant agents are not recommended for patients with hip osteoarthritis (OA) pain.

 

Gabapentin for Peri-Operative Pain Relief:

Gabapentin is recommended for the treatment of perioperative pain and to reduce the need for opioids after total hip arthroplasty. Indications include perioperative use, particularly in procedures like arthroplasty. The frequency, dose, and duration are limited to the immediate perioperative period, typically lasting a few days. Discontinuation is warranted upon completion of the course, sufficient recovery, pain resolution, intolerance, or the emergence of adverse effects.

 

Opioids for Acute, Subacute, or Chronic Hip Pain:

Opioids are not recommended for the treatment of acute, subacute, or chronic hip pain.

 

Skeletal Muscle Relaxants for Hip Pain:

Skeletal muscle relaxants are not recommended for treating acute and subacute, moderate to severe hip pain.

 

Capsicum for Acute or Subacute Hip Pain:

Capsicum is recommended for the short-term treatment of acute or subacute hip pain, as well as for acute exacerbations of chronic hip pain, serving as a counterirritant. Indications include temporary flare-ups of chronic hip pain or acute/subacute hip pain. The frequency, dose, and duration of use for patients with chronic pain are limited to an acute flare-up period, generally lasting no more than two weeks. Caution is advised to avoid application near the genitals. Discontinuation is recommended upon the resolution of pain, completion of a course, intolerance, or the emergence of other adverse effects.

 

Lidocaine Patches for Hip OA Pain:

Lidocaine patches are not recommended for treating hip osteoarthritis (OA) pain. The evidence supporting the use of lidocaine patches for this purpose is not provided.

 

Eutectic Mixture of Local Anesthetics (EMLA) for Hip OA Pain:

Eutectic Mixture of Local Anesthetics (EMLA) is not recommended for treating hip osteoarthritis (OA) pain.

Glucosamine Sulfate, Chondroitin Sulfate, and/or Methylsulfonylmethane for Hip OA

Glucosamine sulfate, chondroitin sulfate, and/or methylsulfonylmethane are not recommended for the treatment of hip osteoarthrosis. The evidence supporting the use of these substances for hip OA treatment is not provided.

 

Complementary or Alternative Treatments or Dietary Supplements for Hip OA:

Complementary or alternative treatments, as well as dietary supplements, are not recommended for the treatment of hip osteoarthrosis.

 

Treatments

Cryotherapy for Hip OA, Arthroplasty, and Surgery:

Cryotherapy is recommended for acute, subacute, or chronic hip osteoarthritis (OA), as well as for patients undergoing hip arthroplasty and surgery. The suggested frequency involves approximately three to five self-applications per day as needed. Discontinuation is indicated upon resolution of symptoms, adverse effects, or non-compliance.

 

Heat Therapy for Acute, Subacute, or Chronic Hip OA:

Heat therapy is recommended for acute, subacute, or chronic hip osteoarthritis (OA). Similar to cryotherapy, the suggested frequency is approximately three to five self-applications per day as needed. Discontinuation is warranted upon resolution of symptoms, adverse effects, or non-compliance.

 

Diathermy for Hip Osteoarthrosis or Pain:

Diathermy is not recommended for the treatment of hip osteoarthrosis or for patients experiencing acute, subacute, or chronic hip pain.

 

Infrared Therapy for Hip Osteoarthrosis or Pain:

Infrared therapy is not recommended for the treatment of hip osteoarthrosis or for patients with acute, subacute, or chronic hip pain.

 

Ultrasound Treatment for Hip Osteoarthrosis or Pain:

Ultrasound treatment is not recommended for the treatment of hip osteoarthrosis or for patients with acute, subacute, or chronic hip pain.

 

Low Level Laser Therapy for Osteoarthrosis or Hip Pain:

Low Level Laser Therapy is not recommended for the treatment of osteoarthrosis or for patients experiencing acute, subacute, or chronic hip pain.

 

Self-Application of Heat Therapy for Osteoarthrosis:

Self-application of heat therapy is recommended for the treatment of osteoarthrosis, particularly for individuals with hip osteoarthritis (OA) and those preferring non-medicinal treatments. The indications encompass a broad range of patients who may benefit from this approach.

The frequency, dose, and duration of applications may vary, and they can be either periodic or continuous. Importantly, applications should be home-based, as there is no evidence supporting the efficacy of provider-based heat treatments. The emphasis, especially for patients with chronic pain, should generally be on functional restoration program elements, with less focus on passive treatments. Discontinuation is warranted in cases of intolerance, increased pain, the development of a burn, or any other adverse event.

 

Rehabilitation

Rehabilitation following a work-related injury should be geared towards restoring functional ability necessary for daily and work activities, with the ultimate goal of returning the patient to their pre-injury status to the extent feasible. The focus should be on active therapy, where the patient exerts effort to complete specific exercises or tasks. While passive therapy, which relies on modalities delivered by a therapist, can play a role in facilitating progress, active interventions should be prioritized over passive ones. It is essential to instruct the patient to continue both active and passive therapies at home to maintain the achieved improvement levels. Assistive devices may also be incorporated into the rehabilitation plan as an adjunctive measure to facilitate functional gains.

 

Therapeutic Exercises – Physical / Occupational Therapy:

Strengthening exercises are recommended for the treatment of hip osteoarthritis (OA) as part of physical or occupational therapy. The frequency, dose, and duration of therapy may vary based on the severity of functional deficits. Total visits can range from as few as two to three for patients with mild deficits to up to 12 to 15 for those with more severe deficits, provided ongoing objective functional improvement is documented. If ongoing deficits persist, more than 12 to 15 visits may be indicated, particularly if there is documentation of progress towards specific objective functional goals (e.g., range of motion, advancing ability to perform work activities). A home exercise program should be developed and performed in conjunction with therapy as part of the overall rehabilitation plan.

 

Walking Aid: Cane / Crutches / Walker:

For select cases of moderate to severe acute hip or groin pain, as well as subacute and chronic hip or groin pain, the use of walking aids such as canes, crutches, or walkers is recommended. Indications include disabling, moderate to severe chronic hip osteoarthritis (OA) where the benefits of increased mobility outweigh the risks of potential debility associated with device use.

The primary benefits are improvements in mobility and walking distance. Discontinuation is indicated upon the resolution of symptoms (e.g., post-operative recovery). The rationale involves the potential helpfulness of crutches and canes during the recovery and rehabilitative phases for acute injuries, while caution is advised for chronic hip pain as crutches may paradoxically increase disability through debility. Therefore, the decision to use or maintain the advice for crutch or cane use should be carefully considered against potential risks.

 

Orthotics, Shoe Insoles, and Shoe Lifts:

The use of orthotics, shoe insoles, and shoe lifts is recommended for patients with a significant leg length discrepancy contributing to hip pain. Indications include a leg length difference of usually at least 2cm, with hip pain or another adverse health attribute believed to be related to the differing lengths. Discontinuation is warranted in cases of lack of efficacy. These interventions are suggested for select patients with significant leg length discrepancies felt to be producing or contributing to symptoms.

 

Magnets and Magnetic Stimulation:

Magnets and magnetic stimulation are not recommended for the treatment of osteoarthrosis or acute, subacute, or chronic hip pain.

 

Massage:

Massage is not recommended for the treatment of hip osteoarthrosis.

 

Reflexology:

Reflexology is not recommended for the treatment of hip osteoarthrosis or acute, subacute, or chronic hip pain.

 

Electrical Therapies:

Electrical therapies, including electrical stimulation therapies and transcutaneous electrical stimulation (TENS), are not recommended for the treatment of hip osteoarthrosis or acute, subacute, or chronic hip pain.

 

Acupuncture:

Acupuncture is recommended for select patients in the treatment of chronic osteoarthrosis of the hip, serving as an adjunct to more efficacious treatments. Indications include moderate to severe chronic osteoarthrosis of the hip, with prior treatments including NSAIDs, weight loss, exercise (including a graded walking program and strengthening exercises).

The recommended frequency, dose, and duration involve a limited course of six appointments with clear, achievable objectives and functional goals. Additional appointments should only be considered if documented functional benefits, lack of plateau in measures, and the probability of obtaining further benefits are observed. Indications for discontinuation include resolution, intolerance, and non-compliance, including non-compliance with aerobic and strengthening exercises.

 

Pre-Operative Exercise:

Pre-operative exercise is recommended for patients exhibiting evidence of weakness or an unsteady gait, with flexibility components considered reasonable for those without fixed deficits. All arthroplasty patients may benefit, especially those with weakness or an unsteady gait, and those needing supervised encouragement.

The benefits include improved speed of post-operative recovery and the potential for enhanced long-term results. The recommended frequency, dose, and duration involve one pre-operative course, with two or three follow-up appointments for adherence and additional exercise instruction needed for select patients.

Severe deficits may require two to three appointments a week for four to six weeks before arthroplasty, while those with minimal deficits may benefit from a single appointment to teach programmatic elements for a self-directed program. Indications for discontinuation include the achievement of program goals, resolution of strength or gait deficits, intolerance, or noncompliance.

 

Post-Operative Exercise and/or Rehabilitation Program:

For hip arthroplasty surgery patients, post-operative exercise and/or rehabilitation programs are recommended. The frequency, dose, and duration are primarily based on progress, with two or three times weekly sessions in outpatient settings gradually tapered as home exercises are instituted and the patient’s recovery advances. In more severe cases, courses of up to three months may be required. Indications for discontinuation include the attainment of goals, achievement of a plateau, or non-compliance.

Late Post-Operative Exercise Program After Arthroplasty or Hip Fracture:

A late post-operative exercise program is recommended for patients exhibiting significant evidence of weakness or an unsteady gait, with indications being ongoing significant deficits in function, gait, strength, and activity level beyond 3 months post-operatively. Discontinuation is warranted in the case of a lack of progressive functional gain.

 

Injection Therapy

Intraarticular Glucocorticosteroid Injections:

Intraarticular glucocorticosteroid injections are recommended for the treatment of hip osteoarthrosis. Indications include hip osteoarthritis (OA) pain that remains unsatisfactorily controlled with NSAIDs, acetaminophen, weight loss, and exercise. The recommended frequency, dose, and duration involve administering one injection and evaluating the results. Generally, one injection is performed, and a second injection may be considered if there is incomplete improvement (increased function and decreased pain).

 

Intraarticular Hip Viscosupplementation Injections:

Intraarticular hip viscosupplementation injections are not recommended for the treatment of hip osteoarthrosis.

 

Intraarticular Platelet-Rich Plasma Injections:

Intraarticular platelet-rich plasma injections are not recommended for the treatment of hip osteoarthrosis.

 

Prolotherapy Injections:

Prolotherapy injections are not recommended for the treatment of acute, subacute, or chronic hip pain.

Botulinum Injections:

Botulinum injections are not recommended for hip osteoarthrosis or other hip disorders.

Glucosamine Sulfate Intra-Muscular Injections:

Glucosamine sulfate intra-muscular injections are not recommended for the treatment of hip osteoarthrosis.

 

Glucosamine Sulfate Intra-Articular Injections:

Glucosamine sulfate intra-articular injections are not recommended for the treatment of hip osteoarthrosis.

 

Surgery

Hip Arthroplasty:

Hip arthroplasty is recommended for severe arthritides, osteonecrosis with collapse, insufficient response to non-operative treatment, or substantially symptomatic hip dysplasia.

 

Osteotomy:

Osteotomy is recommended for the treatment of hip osteoarthrosis in select patients. Indications include significant alignment abnormalities, dysplasia, osteonecrosis, nonunion of femoral neck fracture, slipped capital femoral epiphyses, and coxa vara. This procedure is generally performed on younger patients in preference to arthroplasty, considering the absence of other proven treatments for many advanced conditions. The evidence supports the use of osteotomy in these cases.

 

Post-Operative Exercise and Rehabilitation Program:

Post-operative exercise and rehabilitation programs are recommended for hip arthroplasty surgery patients.

 

Post-Operative Assistive Devices (Walking aid, ADL Adaptive equipment):

Post-operative assistive devices, such as walking aids and adaptive equipment for activities of daily living (ADL), are recommended as needed after hip arthroplasty.

 

Treatment of Infected Prosthesis:

The recommended approach for the treatment of an infected prosthesis is surgical debridement, drainage, and appropriate antibiotics. Treatment often requires prolonged intravenous (IV) antibiotics and may involve the removal of implanted hardware.

 

Treatment of Dislocations:

Referral back to the treating surgeon is recommended for the treatment of dislocations, as appropriate, to reduce dislocation and prevent recurrence.

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